Presentation on theme: "Pain Management by Acupuncture"— Presentation transcript:
1Pain Management by Acupuncture Borjis Holistic Health ClinicDr. Ansari
2Acupuncture Pain Management Part I: TheoryOverview of scientific bases of acupunctureMechanisms of pain managementCurrent researches and clinical trialsPain Scores and evaluation methods
3Scientific Bases of Acupuncture NeurohumoralMorphogeneticNerve Reflex TheoryThe gate control theory of painEndorphin
4Neuro-humoral Approach Peripheral nervous system to be crucial in mediating the acupuncture analgesiaMeridian-Cortex-Viscera correlation hypothesis
5Neurohumoral Approach Acupoint-brain-organAcupuncture stimulates to brain cortex and nerve system, then control the chemical or hormone release to the disordered organs.
6Morphogenetic Theory Shang C. China, 1989 Acupuncture points are singular points in surface bioelectric fieldThe role of electric field in growth control and morphogenesisOrganizing centers have high electric conductanceAcupuncture points originate from organizing centers
7Nerve Reflex Theory -Ishikawa and Fujita et al, Japan, 1950s Autonomic nervous system extending thru the internal organsViscera-mutinous reflexCutanous –Viscera reflexAcupuncture utilize these reflexes for restoring the homeostasis of the body and acceralate the healing process.
8The Gate Control Theory Drs Melzack and Wall, 1965 Model for acupuncture pain reliefSpecific nerve fibers that transmit pain to the spinal cord (substantia gelatinous)Balance between Stimulation & inhibitory fibersShort term block pain by acupuncture ( did not explain the prolong effect)
9Endorphin Theory Dr. Pomeranz, Canada, 1996 Natural MorphineAcupuncture trigger the release of endorphin into the central nervous systemOnly deal with painCorticoids and Substance P also released along with endorphin
13Meridian-Cortex-Viscera Correlation Hypothesis 1. The meridian system is and connected the nervous system to the cerebral cortex.2. It acts through neurohumoral mechanisms3. Acu-point-Brain-organ model: stimulates the brain cortex/nervous system, then controlling the chemical or hormone release to the disordered organs for treatment.
14Morphogenetic Singularity Theory Acupuncture points are singular points in surface bioelectric fieldConverging points of surface current for change in electric current flow.Abrupt transition from one state to another.Eg: BaiHui (Du 20)
15Physical characteristics of the acupuncture points-WHO Points are corresponds to the high electrical conductance points on the body surfaceHigh density of gap junctions at the epithelia of the acupuncture points.Gap junctions are hexagonal proteins that facilitate intercellular communication and increase electric conductivity.
16Research on Auricular points WHO found 43 points have proven therapeutic valueTherapeutic effect can be achieved by needling, temperature variation, laser, ultrasound, and pressure.
17Effects of Acupuncture on the Brain UCI-Use functional MRI to investigate the mechanisms of acupuncture analgesiaStimulates Li 4 revealed activation of visual cortex.Needling Tin Hui revealed auditory cortex activation
18Effects of acupuncture on the Brain-auditory cortex
19Why acupuncture has fewer side effects? May indirect adjust the process and restore normal function by activating the network of organizing centers in the organismThe activation of the self-organizing activity is less likely to cause the side effects resulted from directly antagonizing a pathological process which often overlap with other normal and beneficial physiological processes.
20The role of electric field in growth control and morphogenesis Enhanced cell growth toward cathode and reduced cell growth toward anode in electric fields of physiological strengthFast growing cells tend to have relative negativity polarity.The polarity is due to the increased negative membrane potential generated by mitochondria at high rate of energy metabolism
21Efficacy, effective, safety and costs of acupuncture for chronic pain Evaluated 304,674 patients over 10,000 physicians and received 10+ acupuncture for painResults: acupuncture was an effective and safe treatmentThe effects attributed to specific or nonspecific mechanisms and depend on the diagnosis-results a large research initiative.
22Mechanisms of acupuncture for Pain relief Polymodal receptors(PMRs) in the acupuncture points are sensitized for the immediate action.Action mediated by endogenous opioidsPotent stimulus for activating the analgesic systems
23Therapeutic Mechanisms of Acupuncture -Dr.D. Kendall, 1980 Inserting a needle provokes an acute defensive inflammatory responseAfferent nociceptive (pain) neurons distribute to the dorsal horn of the spinal cordTrigger the gamma loop efferent in the ventral horn and activate neurons that cross over the spinal cord to the brainActivate somatic motor nervesTo muscles, and autonomic motor nerves to peripheral blood vessels and to the internal organs
24Acupuncture Pain Management Part II: Clinical applicationsDifferential diagnosis and treatment forHeadache & migraines, Trigeminal neuralgia,Carpal Tunnel Syndromes, Arthritis, Neckpain, Fibromyalgia, lumbago and sciaticneuralgia.
25Etiology of HeadacheBlood Vessels that become dilated enlarged or constrictedMuscles in the neck and head become tight or tenseMuscles around the eyes the become strained due to overworkSinuses became swollen due to allergies or infectionsNerves that transmit abnormal pain signalsJoints in the jaw and neck are overused or damaged.
26Types of Headache -Western Medicine Vascular headache (Migraines)Muscle contraction headacheCombined vascular & muscle contraction headacheHeadache of nasal vasomotor reactionsHeadache of delusional conversion or hypochondriacal states
27Migraine Headache Classic Migraine Common migraine Cluster headache Hemiplegic and ophthalmoplegic migraineLower half headache
29TCM Classification of headache Headache due to invasion of pathogenic wind into the channels and collateral:Headache occurs often, especially on exposure to wind.The pain may extend to the nape of the neck and back region.Tongue white coating, pulse floating
30TCM Classification of headache 2. Headache due to upsurge of liver-yang:Headache distension of the head, irritability, hot temper, dizziness, blurred vision,Tongue red with thin and yellow coatingPulse thin wiry and rapid.
31TCM Classification of headache 3. Headache due to deficiency of qi and blood:Lingering headache, dizziness, blurred vision, lassitude, pale complexionTongue pale with thin white coating’Pulse thin and thread
32Trigeminal Neuralgia (TN) Causation:-blood vessels compressing the Trigeminal nerve root as it enters the brain stemPeripheral pathology-neurovas compressionCentral pathology- hyperactivity of the trigeminal nerve nucleus
33Classifications of TN Western Medicine: Eastern Medicine Typical AtypicalPre-TNMS-related TNSecondary or tumor relatedTN neuropathyPost traumatic TNEastern MedicinePathogenic wind and coldAscending of Liver and stomach fireDeficiency heat due to liver yin depleteDamp/heat or damp cold accumulation
34TN-Pathogenic Wind & Cold Clinical manifestation:Acute onsetUsually affects V1 sensoryAversion of wind & cold or aggravated byPain like cutting, boring and electric shock but transient ( few minutes)sWind cold or wind heat symptoms
35Tx-TN Pathogenic wind & cold Acupuncture:Yang bai, (GB14)Taiyang, (extra)Zan Zhu (Bl 2)Wai guan (SJ5)He Gu (Li 4)Herbal formula:Jin Fang Bai du San plus Ginger
36TMJ-Tempro mandibular joint Dysfunction syndrome Symptoms:Grinding teeth,Joint pain,HeadacheRinging in the earsUnable to open his or her month wide or hear a “pop” upon opening
37TN-acupuncture treatment Li 3 or Li 4 plusTemporal branch:Taiyang, G 3 & G 14Maxillary branch:G1, St2, SI18, and ST3Mandibular branch:St6, St 5, and G2
41OsteoarthritisArthritis due to destruction of the cartilage, bone and ligamentsCausing deformity of the jointsDamage to the joints can occur early in the disease and be progressive
42Rheumatoid Arthritis Auto-immune disease Chronic inflammation of the tissue around joints , organ and bodyBody tissues attacked by own antibodies in the blood level which causes inflammation.Women to men: 3:1
43Osteoarthritis 90% of arthritis Destruction of the cartilage, bone and ligaments causing deformity of the jointsDamage to the joints can be progressive
45Principle Acupuncture Points for Arthritis Temporo-mandibularST7, SI 19, T 17, Li 4Shoulder joints:LI 15, T14, SI 11, T3,G 34Elbow joints:Li 11, T10, Li 4Wrist & joints:T5, Li 10., LI. 4Lumbar spinal joints:Huatuoparaspinal acupoints, UB37 and UB 40LumbosacraJoints:GV3, B30, B 25, B40 B 60Sacroiliac Joints:B 27, B28Hip joints:G 30, G 29, G34, G39G30, G 29, G34, G39Knee joints:St 34,St 36, Sp 9,G 34Ankle joints:ST 41, T 40, K3, B50, G 35 K8Metatarsophala-ngeal joints:Sp 4, B 65, G 38, Sp 5
50Diagnosis of CTSNumbing pain in the distribution of the median nerve but not limited to it.Phalen’s sign positiveTinel’s sign positiveLight touch/vibratory touch positiveMuscle weakness and atrophyEMG: slowed conduction velocity across the CT.
51Etiology of CTS Median nerve compression by tendonitis Usually due to repetitive motion of the wrist and hands.
64Referred and Interactive Low Back Pain The frequent referral of “ somatic pain into the limbsCause of the cause: Identify the source of symptoms.Make realistic prognosis based on the stage, severity, stability and irritability of the dysfunction
68Traumatic Injury-Brain-TBI Clinical manifestations:Altered mental statusCommunication disordersEmotional and psychitric disordersRelated paralysis or paresthesiaDx: Refer to physician for further investigation.
72Diagnosis of Fibromyalgia Widespread aching > 3 monthsSkin roll tenderness & hyperemiaDisturbed sleep with morning fatigue and stiffnessAbsence of lab. Evidence of inflammation or muscle damageBilateral tender points in at least 6 areas.